Grievance And Appeals Coordinator

Grievance & Appeals Specialist

Position Summary

The Grievance & Appeals Specialist is responsible for managing member grievances and appeals by conducting thorough investigations, gathering supporting documentation, and ensuring compliance with all regulatory requirements. This individual serves as a key liaison between members, providers, internal departments, and regulatory agencies while maintaining strict adherence to turnaround times and quality standards.

Key Responsibilities

• Investigate member grievances and appeals by collecting, reviewing, and analyzing supporting documentation from internal departments, contracted provider organizations, and external entities.
• Communicate with members, providers, and other stakeholders to obtain necessary information and ensure timely case resolution.
• Accurately document case activity, findings, and follow-up actions in accordance with established procedures.
• Escalate complex or clinically sensitive cases to nursing staff or management as appropriate.
• Track, monitor, and manage assigned cases throughout the grievance and appeal lifecycle to ensure compliance with regulatory and organizational deadlines.
• Prepare and submit responses to regulatory agencies within required timeframes.
• Generate and distribute member and provider correspondence related to grievance and appeal determinations.
• Maintain a strong understanding of Medicare benefits, health plan policies, and grievance and appeal processes.
• Utilize established workflows, desktop procedures, job aids, and departmental resources to perform responsibilities efficiently.
• Identify process improvement opportunities and communicate operational challenges to leadership.
• Participate in weekend on-call coverage as assigned.
• Protect member confidentiality and maintain compliance with all privacy, regulatory, and organizational standards.
• Adhere to quality assurance, compliance, and performance expectations to support departmental and organizational goals.

Required Qualifications

• High School Diploma or equivalent required.
• 2-3 years of experience handling grievances and appeals within a healthcare, health plan, managed care, or insurance environment.
• Strong understanding of healthcare terminology, claims processing, and member services.
• Experience working with Medicare Advantage plans strongly preferred.
• Proficient in Microsoft Office Suite, including Word, Excel, Outlook, PowerPoint, and Teams.
• Strong organizational, investigative, and critical thinking skills.
• Excellent written and verbal communication skills with the ability to interact professionally with members, providers, and regulatory agencies.

Preferred Qualifications

• Experience with IKA, MHK, QNXT, or similar healthcare systems.
• Knowledge of Medicare, CMS, and managed care regulatory requirements.
• Prior experience working in a health plan or payer environment.

Key Skills

• Grievances & Appeals
• Healthcare Claims
• Medicare Advantage
• Managed Care
• Medical Terminology
• Regulatory Compliance
• Case Investigation
• Member Services
• Documentation Management
• Provider Relations

Ideal Candidate

The ideal candidate is detail-oriented, highly organized, and experienced in managing complex grievance and appeal cases within a healthcare or managed care environment. They possess strong analytical skills, understand regulatory requirements, and can effectively communicate with members, providers, and internal stakeholders while maintaining strict compliance standards.

This is a Contract position based out of Long Beach, CA.

The pay range for this position is $24.00 - $24.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on Oct 9, 2026.

About TEKsystems

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

About TEKsystems and TEKsystems Global Services

Were a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. Were a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. Were strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. Were building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.